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Lupus Nephritis

What is Lupus Nephritis?

What are the tests for Lupus Nephritis?

Cause of Lupus Nephritis

Symptoms of Lupus Nephritis

How to diagnose Lupus Nephritis

Stages of Lupus Nephritis

Diet of Lupus Nephritis

What are the treatments for Lupus Nephritis

What is Lupus Nephritis?

Systematic Lupus Nephritis is a secondary renal glomerular disease caused by SLE (Systemic Lupus Erythematosus), a disease of immune system and can affect various organs of our body like skin, kidney and nerves. According to clinical survey, among Lupus Nephritis patients, women accounts for more, especially those aged 20 to 40.

Lupus Nephritis is an autoimmune disease. Because of immunodeficiency, SLE patients produce various autoantibodies like antinuclear antibodies, anti-histone antibody and so on. Antigen invade patient's body and combine with these antibodies, as a result of which, large amounts of immune complexes are formed in blood. These immune complexes may deposit in different organs of our body and once they deposit in renal glomeruli, a part of kidney, Lupus Nephritis occurs.

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What are the tests for Lupus Nephritis?

·General Test

About 80% Lupus Nephritis have anemia condition, so testing red blood cells is helpful for diagnosing Lupus Nephritis.

·Immunologic Test

1.Antinuclear Antibodies: Test for abtinuclear antibodies is of high sensitivity, but low specificity.

2. Anti-double stranded DNA Antibody: Anti-double stranded DNA antibody is one of the marked antibodies.

3. Anti-SM and anti-RNP antibodies: About 26% to 45% Lupus Nephritis patients are tested to have anti-RNP antibody. Besides, anti-SM antibody has a special meaning for diagnosing Lupus Nephritis, particularly for Systemic Lupus Erythematosus.

4.Anti-histone Antibody: Anti-histone Antibody can be tested in Lupus Nephritis and sometime in rheumatic arthritis and Sjoegren syndrome.

5.Other antibodies like Anti-SSA antibody and anti-SSB antibody

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Cause of Lupus Nephritis

In normal condition, immune system protects our body from being damaged by harmful substances. However, due to abnormal immune system, our body fail to tell the difference between harmful substances and healthy ones. As a result, antigen invade our body and combine with antibody generated by our body.

Immune complex is the combination of antigen and antibody. They circulate with blood and may deposit in every part of our internal organs. When they deposit in kidney, large amounts of inflammatory mediators accumulate around the immune complexes and give rise to inflammatory response which is the direct cause for damaged renal functional cells. As more and more renal intrinsic cells are damaged, kidney damages become more serious and consequently, kidney function is impaired.

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Symptoms of Lupus Nephritis

Firstly, patients with SLE have symptoms in the whole body such as intermitted fever, red spot in face the shape of which looks like butterfly, painless oral ulcer, nonerosive arthritis and hematologic disorders. In addition, patients can also have abnormal mental condition and pale face after touching cold. After that, face looks purple, and then turns normal.

Secondly, patients with SLE can also have symptoms in kidney. They may suffer from pure hematuria or pure proteinuria, or hematuria and proteinuria accompanied by edema, discomforts of back or high blood pressure, which is quite similar with renal glomerular nephritis. What's more, patients can also have hematuria and proteinuria which is accompanied by acute renal function decline.

Thirdly, patients with SLE can also have abnormal physical test such as blood test. The amount of white blood cells decreases or the blood cells decreases, the complement C3 decreases, and the autoantibody shows positive. In addition, renal biopsy can also help diagnose the degree how kidney is damaged.

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How to diagnose Lupus Nephritis

In the above, we know about the symptoms. How do we know it is lupus nephritis? By renal biopsy, we can see the immune complex deposit onto the renal glomerular epithelial cells. We can also judge lupus nephritis by the following inducement which can also help doctors get a systematic diagnosis.

Stage 1- high filtration and high perfusion stage. Glomerular Filtration Rate(GFR) is higher than normal.

Firstly, people lack complement, suffer from disorder of hormones or influenced by genetic factors.

Secondly, in daily life, people get infected unconsciously, or eat something wrong.

Thirdly, people take in something toxic or influenced by excessive ultraviolet rays.

Due to genetic factors and environmental factors, they interact each other in the body, which leads to more abnormal condition in the body, thus invading kidney and forming lupus nephritis.

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Stages of Lupus Nephritis

In histology, Lupus Nephritis is divided into 6 stages:

Stage I: Minimal Mesan Gial. Stage I of Lupus Nephritis looks normal under microscopy, but mesangialcal deposits are noted in electron microscopy. In this stage, urinalysis is still normal.

Stage II: Mesangial Proliferative. Stage II of Lupus Nephritis is marked by mesangial hypercellularity and matrix expansion. Besides, symptom of microscopic hematuria and proteinuria may be seen.

Stage III: Focal Lupus Nephritis. Sclerotic lesions of <50% of the glomeruli is the typical feature of stage III Lupus Nephritis.

Stage IV: Diffuse Proliferative Lupus Nephritis. Stage IV of Lupus Nephritis is the most severe and the most common subtype and in this stage, more than 50% of glomeruli are involved.

Stage V: Membranous Lupus Nephritis. Stage V of Lupus Nephritis is characterized by diffuse thickening of the glomerular capillary wall, with diffuse membrane thickening ,a nd supepithelial deposits seen in electron microscopy.

Stage VI: This is the last stage and it usually is called Advanced Sclerosing Lupus Nephritis. The final stage of Lupus Nephritis is represented by global sclerosis > 90% of glomeruli, and represents healing of prior inflammatory injury, as well as chronic class III, IV V.

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Diet of Lupus Nephritis

First, patients with Lupus Nephritis should forbid greasy food, which contains much fat, because patients with Lupus Nephritis have lesion in the blood. In addition, the food should also be delicate and should not be too salty. If they take in too much salt, there will be too much water in the body, which leads to the retention of water. So the intake of salt should be less than 3 g per day.

Second, patients with Lupus Nephritis should forbid sea food such as fish, shrimps, crubs, and so on. All of these foods can lead to allergic reaction. In addition, beef and milk can also lead to the deterioration of condition. So the amount of them should also be limited. The intake of beef every week should be kept at 100 to 19g. The intake of milk every day should be under 100 to 159g.

Third, patients with Lupus Nephritis should control the intake of fat, especially food which is rich in fat such as pork, beef and mutton. They should also stop fried food. In addition, they should take in good quality protein, which mainly refers to animal protein, such as lean meat, and kinds of fish which has scale. What's more, according to the type of Lupus Nephritis and different symptoms in clinic such as edema and blood pressure, they should choose specific amount of salt.

For example, if patients with Lupus Nephritis are diagnosed with Nephrotic Syndrome, the intake of salt every day should be kept at under 3g.

Last but not least, because patients with Lupus Nephritis use hormone and other medicine for a long time, they are easy to be in the insufficiency of vitamin B, C, D and so on. So they should also take in more vitamins from fresh vegetables and fruits.

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What are the treatments for Lupus Nephritis

Conventional Treatment

As Lupus Nephritis is an autoimmune disease, so in many countries, patients are prescribed hormone medicines like prednisone, cyclophosphamide, cyclosporinA and tripterygium to control the disease. As we have explained above, Lupus Nephritis progress on the basis of inflammatory response. These immunosuppressive medicines block inflammatory response effectively and immediately for the time being, however, as immune complexes are not cleared away, inflammatory response appears again once they stop taking medicines or once reducing the dose. This is the reason why Lupus Nephritis relapses easily.

Immunosuppressive medicines shows visible treatment effects in short term, but unfortunately, they are fail to clear immune complexes away from kidney. Besides, long-term application of these medicines will lower patient's immunity and cause different kinds of side effects.

Treatment effects of immunosuppressive medicines can not be ignored, but we also need to realize that as long as immune complexes keep staying in kidney, inflammatory response appears sooner or later. Every relapse of inflammatory reaction will cause further kidney damages and finally, Lupus Nephritis will run to kidney failure that needs patients to do dialysis or kidney transplant to maintain their life.

Plasma Exchange

Plasma Exchange, as one of the dominant blood purification methods, is said to have great effects in treating Lupus Nephritis through removing circulating immune complexes, autoantibodies such as anti-double-stranded DNS, anti-SSA and other immune reactants. These immune complexes deposit in kidney and cause inflammatory response which is the direct cause for kidney damages.

Therefore, by clearing them away, no immune complexes lodge in kidney again and consequently, Lupus Nephritis can be controlled to some extent.

However, some people have different attitude toward efficacy of plasma exchange in patients with Lupus Nephritis by holding the idea that the so called antibody and immune complexes will occur after stopping plasma exchange. Also, it is said Plasma Exchange is useful in a small group of Lupus Nephritis patients.

As a matter of fact, plasma exchange can not be regarded as a dominant treatment for Lupus Nephritis, as it only remains helpful in cleaning blood and fail to repair kidney damages. In case of Lupus Nephritis, aside from clearing immune complexes away from blood, repairing kidney damages is the key point for sufferers to recover as well as avoid kidney failure. Thereby, plasma exchange is not a permanent therapy for Lupus Nephritis, but a temporary treatment.

Alternative Treatment for Lupus Nephritis-Immunotherapy

Immunotherapy is an alternative treatment for Lupus Nephritis, but it can not be applied effectively without immunosuppressive medicines, that is to say immunosuppressive medicines play an indispensable role in controlling Lupus Nephritis according to present medical development level.

The whole treatment of Immunotherapy can be mainly divided into 6 steps: immune diagnosis, immune clearance, immune inhibition, immune tolerance, immune adjustment and immune protection.

The first step focuses on figuring out where the immune complex deposits exactly, the amount of immune complex and the exact type of immune response, all of which are extremely important for the following prescription.

The second step is aimed at clearing immune complexes away from blood with different kinds of blood purification technics like plasma exchange, Immune adsorption and hemofiltration. This step helps to avoid more intense inflammatory response by preventing more immune complexes depositing in kidneys.

Step three: on the basis of step one, doctors will choose different types of immunosuppressive medicines to block inflammatory response and this is helpful for avoiding further kidney damages.

Step four: Immune complexes can not be cleared away over night, so we need kidneys to stay with immune complexes for some time and to achieve this purpose, regular application of immunosuppressive medicines is needed.

Step five: Lupus Nephritis is an autoimmune diseases, so treatment should start from immune system and only in this way, can we prevent new immune complexes from being formed. In step five of Immunotherapy, Chinese medicines are applied to adjust Lupus Nephritis patient's immune system so as to achieve the purpose of returning abnormal immune system back to normal.

Step six: Last but not least, immune protection is applied, in which stage, we use medicine which can nourish qi and blood to rebuild the intrinsic immune system, the purpose of which is to protect patient's immune system so as to against the invasion of immunological diseases successfully.

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